Provider Demographics
NPI:1386181956
Name:KING, JENNIFER WILLIAMS (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WILLIAMS
Last Name:KING
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 NEW FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35175-9013
Mailing Address - Country:US
Mailing Address - Phone:256-505-8483
Mailing Address - Fax:
Practice Address - Street 1:235 3RD ST SE
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-1477
Practice Address - Country:US
Practice Address - Phone:256-586-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1921225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist